Making healthcare systems resilient

By Dr. Walid Tohme, Jan Schmitz-Hubsch, and Dima Sayess


The COVID-19 pandemic underscored a harsh truth: many healthcare systems around the world are poorly prepared to provide care for their citizens when facing a health crisis. Many healthcare systems were designed for stable, predictable circumstances and are not resilient enough during times of crisis. That must change. Just as businesses now must adapt to a world of complexity, uncertainty, and volatility, and the healthcare sector must take urgent steps to strengthen its resilience. Governments, regulators, and healthcare providers all must take specific, coordinated steps to make health systems more robust.

As of late May 2021, the COVID-19 pandemic had caused more than 167 million COVID-19 cases worldwide, with nearly 3.5 million deaths. There have been severe economic effects: global GDP in 2021 is forecast to be 5.3 percent lower than pre-pandemic projections, a drop of about $4.7 trillion. Yet it is only the latest in a series of recent public-health disasters, including Hurricane Katrina (1,800 deaths), the 2011 Tōhoku earthquake in Japan (16,000 deaths), and the Ebola epidemic of 2014–16 (a reported 11,310 deaths in Guinea, Liberia, and Sierra Leone).

Healthcare resilience is about more than fending off these dangers. Developing resilient healthcare systems enables a country to prevent, surveil, respond to, and recover in the face of natural disasters or human-caused hazards, reducing vulnerabilities, saving lives and enhancing personal and society-wide security.

Governments need to adopt a holistic and integrated approach to make their healthcare systems more resilient and responsive due to the increasing prevalence of hazards. To guide the building of healthcare system resilience, Strategy& developed an evidence-based framework that enables countries to assess their strengths and weaknesses in three broad areas.

Exposure to hazards

Governments need to consider natural hazards from extreme weather—such as drought and storms, including the impact of climate change­—and infectious diseases and pathogens. They also should assess the threat of human-caused hazards. These include environmental threats such as pollution, along with crime, and political unrest, all of which can put stress on a healthcare system.

Structural vulnerabilities

Governments should assess the vulnerabilities of their health systems. These vulnerabilities include clinical factors such as the access to, and quality of, medical care; population health behavioral considerations such as diet, alcohol and tobacco use, and other lifestyle characteristics; and demographic factors such as fertility rates.

Institutional capacities

Governments should assess how well they can prevent disease, surveil the health of their population, respond to an emerging health threat, and recover in its wake.

Together, these three elements form a baseline from which a country can begin to improve. Once governments know where they stand, they can build systematically through coordinated action among the core stakeholders: the central government (acting both internally and in cross-government efforts), healthcare regulators, and healthcare providers.

The central government must coordinate a multi-level government and international response, providing the policy and legal basis and budget for preparedness activities. It should also develop a master emergency communications plan (including coordination with international actors) and leading regular operational readiness testing exercises.

Healthcare regulators must establish a dedicated national healthcare emergency strategy. Regulators should undertake multifaceted prevention and preparation activities, including system capacity surge plans and long-term public health programs to strengthen the population’s health resilience. They should survey and assess threats on an ongoing basis, and create national response centers that synthesize real-time data and serve as the backbone to coordinate the healthcare system’s response.

Healthcare providers must implement plans to ensure the continuity of critical services and establish local health emergency response operations that are synchronized with national response mechanisms. To that end, healthcare providers need to build strong relationships with communities and other providers to coordinate effective local responses.

Although previous health emergencies have highlighted smaller-scale hazards and vulnerabilities, the COVID-19 pandemic has fully exposed what happens when there is a global health crisis. The pandemic’s implications reach far beyond healthcare systems, also affecting the global economy and the livelihoods of billions of people. It should serve as an urgent signal for governments to make healthcare systems more resilient, responsive, and sustainable. Taking appropriate measures today will be critical to ensuring countries are prepared for a more uncertain future.

This article originally appeared in Gulf Business, October 2021.

About the authors

Dr. Walid Tohme and Jan Schmitz-Hubsch are partners with Strategy& Middle East, part of the PwC network, and Dima Sayess is a partner and the director of the Ideation Center, the leading think tank for Strategy& Middle East.

Contact us

Dr. Walid Tohme

Dr. Walid Tohme

Partner, Strategy& Middle East

Jan Schmitz-Hubsch

Jan Schmitz-Hubsch

Partner, Strategy& Middle East

Dima Sayess

Dima Sayess

Partner and Ideation Center Lead, Strategy& Middle East